MRI findings in brain death

Case contributed by Shekhar Kalia


Background of chronic renal failure, status post renal transplant. She developed sepsis with toxic myocarditis and eventually had cardiac arrest and hypoxic-ischemic brain injury.

Patient Data

Age: 25 years
Gender: Female

MRI Brain


There is tonsillar herniation, loss of intra-arterial flow voids signal, diffuse cortical high signal intensity and swelling of cerebral sulci on T2WI, effacement of bilateral lateral ventricles, high signal intensity in cerebral and cerebellar hemispheres on DWI due to cytotoxic edema and no significant blooming on GRE. 

Case Discussion

MR findings cases of brain death include diffuse swelling of the cerebral gyri and cerebellar cortex, demonstrating iso-hypointense signals on T1WI, getting iso-hyperintense on T2 WI suggestive of hypoxic-ischemic brain injury, with associated tonsillar herniation, effacement of bilateral lateral ventricles and loss of normal flow voids in the intracranial portions of both internal carotid arteries. MR angiography may show a paucity of intracranial vessels at/above the level of the supraclinoid portions of the bilateral internal carotid arteries.

Important: these features are diagnostic of legal brain death and MRI generally is not considered a suitable ancillary test to determine brain death when a clinical determination is not possible or sufficient. Read more about brain death.

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